"Always pick the toughest patient"

  1. 3
    This is advice I've read on here time and time again.. And it seems like sound advice, so I go by it. Obviously you'll probably learn more by taking care of a patient with CHF vs one with cellulitis. However, I'm starting to regret this week's choice. We have to write a care plan with the patho, analyze the labs, and all the patient's meds. We have 36 hours to turn it in, and that includes sleeping time. I also have a job and have to work on Thursdays.

    This week, I chose the toughest patient. This person's admitting dx were neutropenia and pneumonia. Welllllllll...

    The person has metastatic bone and prostate cancer and is receiving radiation for it, which caused his neutropenia. Because of the low WBC count, he acquired C. diff.

    He also has CHF with chronic generalized edema. He has 3+ pitting edema in the lower extremities and 1+ generalized. Along with that, because of the CHF and pooling of fluids, he has atelectasis (I may have spelled that wrong but I'm too tired to look it up at the moment) that caused the pneumonia.

    Now I have to write the patho of all of that, address all the abnormal labs, and write a care plan addressing all the issues. Yes, picking the toughest patient will cause you to learn A LOT, it's true. However, for the sake of my sanity, I may go with a mediocre patient next time.

    This was just a vent, because I'm tired and not going to bed anytime soon because of this, so I needed to get it out, no better place than the lovely internet
    BooBear'sMommy, HappyWife77, and Esme12 like this.
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  4. 0
    Have fun!
    I had something similar. I'd had all these medical patients, and my instructor told me to take an ortho pt, since I hadn't had one yet. I saw a tib/fib fx, so I took him. Oh boy, that was the least of his problems!! He was so complicated we ended up in there for nearly 3 hours trying to stabilize the poor guy, with RT in there for his COPD, ortho in there, several other disciplines as well. We finally got him transferred to the ICU, because he was WAY too complicated for med/surg, and just needed more hands-on care than a med/surg nurse with 3-4 additional patients could feasible handle.
    Many patients will have multiple comorbidities. Look into how they affect one another. It can be quite interesting! I remember another patient with cirrhosis and hep C that ended up with chronic hepatic encephalopathy, and he had every complication that comes with that, as well as an interesting story about how he ended up in the hospital this time with it. Looking up his meds and the disease process was really interesting!
  5. 2
    I agree! After writing patho, I actually learned A TON and it was interesting. I even had an aha! moment with the meds.. The patient is on Synthroid and I couldn't find anywhere in his history about hypothyroidism or thyroid issues in general. After looking more in to it, I found out radiation therapy causes diminished thyroid function, hence the need for replacement. I also knew the patient had metastatic bone and prostate cancer, but I didn't realize the bone cancer was caused by the prostate cancer. I could go on and on about what I just learned from having to write this patient's patho, so it was definitely a learning experience. I just had to write like 3x more than I normally do, and because I'm so crunched for time, it kind of sucks... But on the bright side, I did learn a lot. It's really a double edged sword
    RunBabyRN and Lev <3 like this.
  6. 4
    Quote from twss2323
    I agree! After writing patho, I actually learned A TON and it was interesting. I even had an aha! moment with the meds.. The patient is on Synthroid and I couldn't find anywhere in his history about hypothyroidism or thyroid issues in general. After looking more in to it, I found out radiation therapy causes diminished thyroid function, hence the need for replacement. I also knew the patient had metastatic bone and prostate cancer, but I didn't realize the bone cancer was caused by the prostate cancer. I could go on and on about what I just learned from having to write this patient's patho, so it was definitely a learning experience. I just had to write like 3x more than I normally do, and because I'm so crunched for time, it kind of sucks... But on the bright side, I did learn a lot. It's really a double edged sword
    This sums it up why picking the hardest patient pays off. It's work...but worth it.
    SwansonRN, RunBabyRN, Wise Woman RN, and 1 other like this.
  7. 0
    You're lucky in a sense, twss2323, we had <24 hours to complete our care plan because clinical was the very next day of our choosing the patient. Glad you decided to stick it out with your philosophy; it pays off in the end.
  8. 2
    So - re-framing the discussion a bit....

    The OP is getting waaay more benefit/value from the educational process than fellow students who are taking an easier route. Don't know about you, but I really LOVE paying less for something I really want!!!
    RunBabyRN and Esme12 like this.
  9. 1
    We don't get to pick our patients. They are assigned to us.
    tkg123 likes this.
  10. 0
    I always picked the pts that were easy. No restraints, self ambulating, self turning, no ostomy, self bathing. My NCP's were usually pretty good because I didn't have complex pts. Idon't know how my instructor didn't notice. Isn't that awful?
  11. 2
    Quote from Everline
    We don't get to pick our patients. They are assigned to us.
    We don't get to pick either. And we aren't allowed to do pre-clinicals anymore. The hospitals in our area won't allow it so it makes things a little challenging sometimes.
    tkg123 and Everline like this.
  12. 0
    I'm super jealous that you get to choose your patient and have 36 hours to write the care plan. We have our patients assigned to us when we arrive in the morning and have to turn in the care plan when we leave. It's insane! But, the reasoning behind the madness is that we have to finish our charting when we leave everyday, so this should get us used to it. :-/


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